Anxiety Disorders (phobias)

Anxiety disorders are to do with feelings of fear, apprehension and tension that people experience. Everybody experiences anxiety at some time in their life, a threat will cause a person to be fearful and prepare themselves for the ‘flight or fight’ biological response. However, for some people, the level of anxiety experienced is very high and seriously affects their ability to function properly in everyday life. One common example of an anxiety disorder is phobias.

﻿Definition of a phobia﻿

﻿A phobia is an extreme and irrational fear of an object or situation, which is disproportionate to the actual danger involved, and leads to avoidance of that object or situation. A fear becomes a phobia when it begins to be maladaptive, i.e. when it begins to interfere with everyday life.

SYMPTOMSThe typical symptoms of a phobia are:

Intense and irrational feelings of fear and anxiety, which may be a severe panic attack

Avoidance behaviour, where the person may engage in extreme and complicated behaviours in order to avoid the object or situation that causes panic attacks

Phobias may have a gradual onset or may happen very quickly as a result of a particular experience.﻿

﻿﻿There are three categories of phobia: · Specific phobia – an intense and irrational fear of a particular item or situation, such as animals or places. · Social phobia – a persistent and irrational fear of social situations. Of interacting or performing in front of people. · Agoraphobia – a fear of having a panic attack in a public place. Fear of open spaces.﻿﻿

Types of phobias

﻿Specific phobia﻿

﻿A specific phobia involves a strong fear and avoidance of a particular object or situation. When exposed to the feared object or situation an individual will experience great anxiety, a panic reaction often occurs and the situation or object is usually avoided. Sometimes simply anticipating exposure to the feared object can bring on a panic attack. In addition to the points above, to be diagnosed with a specific phobia the fear must:

Be triggered immediately on exposure to the object or situation

Specific phobias are quite common, affecting 10% of the population, and are more prevalent in women than in men. Fear of dogs might be one common example.Fear of blood is different from other specific phobias as the person may actually faint at the sight of blood and may therefore avoid seeking medical attention.﻿

Social phobia

Fear of social situations. The high levels of anxiety or panic can result in the person performing poorly in front of others. In an interview situation, for example, the person may perform so poorly that they are not offered the job. People with social phobias are often very able, but do not demonstrate this in front of others because the anxiety is so debilitating. Often the anxiety is so strong that it causes avoidance of certain situations altogether. When the social anxiety interferes with work and social life it becomes a clinical condition. Generally people with social phobia feel inadequate in comparison to other people and find relationships difficult. To compensate they may become workaholics or develop all-consuming hobbies. Social phobias occur more in women than men often starting during adolescence and seem to be more common in families where parents and relatives use shame as a way of controlling a child’s behaviour. Social phobias are NOT just "shyness", they are far more.

Agoraphobia

Agoraphobia is a particular fear of open spaces. Approximately 2-3% of the population suffer from agoraphobia and the majority are women. Research has shown that agoraphobia develops as a result of severe panic attacks that the person does not expect to happen (Barlow 2002). There are two types of agoraphobia:1. Agoraphobia as a complication of panic attacks. Agoraphobics are anxious about having a panic attack in a public place and being unable to escape or find help. The person then engages in avoidance behaviour, which results in staying at home, not going outside and becoming fearful at the simple thought of going out. 2. Agoraphobia without panic attacks. This is less common than the above type, and is characterised by a spreading fear of the environment outside the safety of the individual’s own home. This fear gradually increases in severity, until eventually the person can become housebound.

Assignment 1 - Test your diagnosis

Assignment 2 - Section A question

a) Define what is meant by the term 'phobia' (2)b) Describe two different types of phobia (4)

Examples of phobias

Below are a couple of case studies of people with phobias. In both cases, you can start to see some possible treatment methods for the phobias too... Make sure you can pick out the features of these cases which make them a phobia (rather than just a fear). How do they match the criteria given above?

﻿﻿Maintaining phobias - Avoidance conditioning﻿﻿

﻿Classical conditioning works well for explaining how phobias might be formed, but not why they might be maintained. The two-process
theory (or two-factor theory) by Mowrer (1947) involves both classical and
operant conditioning and is generally known as avoidance conditioning.

﻿It suggests that the fear develops through classical conditioning – we learn to associate an object or situation with being frightened. This fear is then maintained by operant conditioning because the person learns that their f﻿ear is reduced by avoiding the stimulus. People will avoid contact with mice and therefore do not get the fearful response – negative reinforcement.﻿ For example, Little Albert would be classically conditioned to fear the rat and this would be maintained by operant conditioning – by avoiding rats, which would reduce his fear response and strengthen his fear of them, making him want to avoid a rat in the future.﻿

The two process theory. Classical and operant conditioning working together to form and them maintain a phobia.

﻿Social learning theory and phobias﻿

Remember SLT from Bandura's experiment...? Recap here if not Phobias could develop as a result of watching/observing another person (the model) experience the pain/upset from an object/situation. If the observer is a young child, the model may be the mother or father. Example: if a mother has a fear of spiders and reacts in a highly emotional and extreme way when there is a large spider in the bath, the child may also develop a phobia for spiders. This is because the mother acts as a role model for the child, and because the strong emotions of the mother towards the spider may frighten the young child. Here, classical conditioning would operate to pair the spider with the fear reaction of the mother, resulting in fear of spiders in the young child.

Evaluation of behaviourist explanations of phobias

There is research evidence to support the explanation that fears can be acquired by a conditioning process. The study of Little Albert demonstrated this. Also there are numerous findings that fear reactions can be readily conditioned in animals in laboratory settings. ﻿However, just because it can be demonstrated that some fears can be acquired this way, does not mean that all fears are acquired in the same way.﻿

People are often able to relate their phobia to a specific experience or stimulus (as the behaviourist explanation would predict). In a study of people with a fear of dogs it was found that 56% relate their fear to a frightening incident with a dog (Di Nardo et al 1988). This gives some support for conditioning butdoes not account for those that people who don’t recall such an incident. Also, a similar number in the control group reported a painful incident with a dog but did not develop a fear. So conditioning does not explain why some people develop a phobia whilst others do not. It is a reductionist and oversimplistic explanation which ignores individual differences.

﻿Attempts to replicate the Watson & Rayner study have been unsuccessful, so the theory may lack reliability.

Fears that develop gradually (e.g. social phobias) and cannot be traced back to a specific incident cannot be readily explained by the behaviourists.

However a major claim against the behavioural approach is that behaviour is inherited and not learned. For example, Seligman suggested that we are biologically prepared from birth to quickly learn a fear association (phobia). This would be a better explanation of why not all people who experience a traumatic event develop a phobia related to it. So the argument made against the behavioural explanation is that it is too focused on the role of nurture and ignores the evidence that nature also has an influence (see biological explanations section).﻿

﻿The Psychoanalytic explanation of phobias﻿

Just like the behaviourist explanation, you've done this before. Remember Little Hans? This is the most famous case of a phobia which was explained using Freud's approach, so you're already a bit of an expert!

Freud's theory is based on the idea that people have unconscious wishes and thoughts that cause unconscious conflict between the ego and the id or superego. The ego is threatened by unconscious conflict and fears that the anxiety caused by the conflicts will overwhelm it. Because the entire ego’s energy is being used trying to cope with the anxiety or feelings of panic the ego may not be able to function at all. To cope with this, the ego uses the defence mechanism DISPLACEMENT – the anxiety is displaced onto another object or situation. This results in a specific phobia, it is less threatening to the individual to have a phobia than it is to have the unconscious thoughts and conflicts without trying to do anything about them. Either way the person is trapped in a no-win situation since the phobia can be as debilitating as the original unconscious thoughts and desires.

Assignment 4 - Remembering Little Hans

Look back at the study of Little Hans. How does this case fit with the theory described above? Write a short summary of Hans' phobia from Freud's perspective. How is displacement occuring? What are the unconscious thoughts causing anxiety? What symbols are created by the sufferer?

﻿Other phobias from a psychodynamic perspective﻿

﻿In similar fashion to Freud other Psychodynamic theorists have argued that a fear of spiders hides unconscious conflicts. For example, according to Sperling (1971) a fear of spiders is a defence against more threatening impulses of a sexual nature. Abraham (1927) proposed that the fear of spiders is symbolic of an unconscious fear of sexual genitalia. The psychodynamic approach explains agoraphobia as resu﻿lting from separation anxiety experienced by a young child. This is at the unconscious level and is to do with irrational thoughts that the child has about being separated from the mother and the realisation of dependency on the caregivers. Agoraphobia serves the function of keeping the person at home, and for the unconscious, irrational mind this reduced separation anxiety. This is because, unconsciously, the person thinks that separation from either or both parents is less likely if the person is at home all the time. ﻿

﻿Evaluating psychodynamic treatments of phobias﻿

Assignment 5 - how would you explain these phobias

You are Sigmund Freud. How would you use psychodynamic theory to explain the phobias in the document below?

﻿The psychodynamic explanation for Hans’ phobia for horses is complicated and the behaviourists provide a much simpler explanation. At age 4, Hans had witnessed an accident when a horse collapsed in the street. This greatly upset him and he could have been classically conditioned after the incident to fear horses.

Freud’s theory of anxiety lacks methodological thoroughness, for example, evidence for Freud’s theory of phobias is drawn from clinical case studies, and these are limited in number and subjectively interpreted, so open to bias.

The approach seems unscientific, as it is very difficult to quantifiably measure things occurring in a person's unconscious.

Freud maintained that adult phobias only occurred in people with sexual problems. However, many people with anxiety and specific phobias have a normal sexual life, and Freud’s assertion is almost certainly incorrect.

﻿Biomedical/Genetic explanations for phobias﻿

﻿Some people seem more susceptible to developing a phobia than others, and therefore a genetic explanation has been proposed to account for these individual differences.

Before you read any further, ASK YOURSELF "What sorts of methods would be used to investigate the genetic basis of phobias?" Based on what you already know from other biological and genetic explanations, you should be able to suggest this in detail already...﻿

﻿Some initial biological evidence - Ost (1992)﻿

J Abnorm Psychol. 1992 Feb;101(1):68-74.Blood and injection phobia: background and cognitive, physiological, and behavioral variables.Ost LG.Author information﻿Abstract: Blood-phobic (n = 81) and injection-phobic (n = 59) patients fulfilling the DSM-III-R criteria for simple phobia were compared on a number of variables. There were no differences between the samples in age at onset, age at treatment, marital and occupational status, history of fainting in the phobic situation, and impairment. Higher proportions of blood-phobic subjects than of injection-phobic subjects reported having first-degree relatives with the same phobia (61% vs. 29%) and reported fearing that they were going to faint in the phobic situation (77% vs. 48%). In b﻿oth samples, these proportions were higher in the subgroup with a history of fainting. Overall 62% of people with a blood and injection phobia reported a 1st-degree relative who shares the same disorder. The prevalence rate for the general population is just 3%. Injection-phobic subjects rated 2 of 11 physiological items higher than did blood-phobics subjects, but the groups did not differ on behavioral variables. Overall, the similarities were more marked than the differences, and it is suggested that these two specific phobias should be regarded as one diagnostic entity. ﻿

Ost (1992) investigated blood and needle phobias

Assignment 6 - summarising research

Read the abstract of the paper by Ost (1992), and produce a summary of the main findings. Then write three conclusions that could be drawn from the research, and three evaluations of it.

'Preparedness' might explain why we see this harmless bit of rope as a snake...

﻿How does the biological explanation work? - Preparedness﻿

﻿The 'preparedness explanation suggests that human beings have a genetic predisposition to develop phobias to certain items and situations, such as fear of darkness, heights open spaces and strangers. These were potential sources of danger to us thousands of years ago. Those individuals who developed such phobias would avoid harmful objects or situations and would be favoured by evolution. Seligman (1971) suggested that there was a ‘preparedness’ (a physiological predisposition) to be sensitive to certain stimuli. It is not the fears themselves that are inborn, rather there is an innate (in-born) tendency to rapidly acquire a phobia to potentially harmful events – we are biologically prepared from birth.﻿

﻿Preparedness - a happy marriage of behaviourism and bio!﻿

﻿Preparedness can be explained equally well from a biological and behaviourist perspectives:

Biological – a readiness to fear certain things could have evolved and then been passed ongenetically

Behaviourist – experience with certain animals, such as snakes or spiders, might have taught us to fear them and in some cases develop a phobia.

On other words, we are genetically programmed to develop classically conditioned phobias more rapidly to certain objects!

EXAM TIP:In the examination you can discuss this theory under either approach! Two for the price of one!﻿

It's common to use different approaches as though they are rivals - but that doesn't always have to be the case. They can work well together too!

﻿Evidence for preparedness - Ohman et al (1975)﻿

﻿AIM Conducted a series of studies to investigate the preparedness explanation of phobia acquisitionMETHOD Participants were shown pictures of houses, snakes, spiders and faces of people. Half the participants received an electric shock whenever they were presented with a picture of a house or a face. The other half received an electric shock whenever they were presented with a picture of a snake or spider.RESULTS Both groups of Pp’s showed fear when subsequently shown pictures they had experienced with an electric shock. This was measured by their skin reaction called galvanic skin response (GSR). Following a period in which Pp’s received no electric shocks it was found that the GSR was higher for those shocked when shown snakes and spiders.CONCLUSION Human beings may be more biologically prepared or read﻿y to develop phobias for animals such as snakes and spiders, which may threaten survival.﻿

﻿Evaluating biological explanations for phobias﻿

GENETIC STUDIES:

﻿You already know the potential problems with twin and family studies! They're the same here. Write a short summary of these evaluations, applying them specifically to the research given here on phobias.﻿

PREPAREDNESS:

﻿Supported by experimental evidence in humans as well as in animal studies. Also, because it uses aspects of both behaviourist and biological ideas, it is a more holistic explanation for the formation of phobias.﻿

﻿The studies on prepared fears have been criticised because there is evidence that the fears acquired under laboratory conditions are easily removed simply by verbal instructions, and therefore these laboratory fears are unlike phobias that people would acquire in the real world - they are not ecologically valid phobias.﻿

Could you have predicted these criticisms? The same issues come up time and time again! The better you understand this, the better you'll do in an exam!

﻿Cognitive explanations for phobias﻿

﻿As you know, in cognitive explanations the fearful response is experienced due to the interpretation or appraisal of events. It is the interpretation of an event that triggers the emotion not the event itself.

When a person has a phobia, their response to a situation/object is immediate and extreme, and the interpretation and appraisal distorted. Phobias form and persist due to three main factors:﻿

Sensitisation

The sufferer becomes unusually 'sensitive' to an object. Anxiety becomes associated with a particular object/situation so that the presence of (or thinking about) it is enough to automatically trigger anxiety.

They may also be hypersensitive to their own body's anxious responses - e.g. their breathing or heart rate. This has been described as cognitive vulnerability (Clark, 1996).

﻿Avoidance﻿

﻿After sensitisation occurs a person will avoid an object/situation and this becomes rewarding because the anxiety decreases.﻿

Irrational or negative thought processes

Over-estimating a negative outcome – ‘what if the snake bites me and is poisonous’

Catastrophising – ‘There would be antidote and I would be disabled or die’

Under-estimating ability to cope – ‘I’d never be able to cope in a wheelchair’

﻿Example of a case study for cognitive explanations - agoraphobia﻿

﻿According to cognitive theory, the agoraphobic person is hypersensitive to spatial layouts in the environment and also to being too far away from a someone who could take care of them. If access to home or the caretaker is blocked then fear is induced and the agoraphobic has an urgent need to return home. They may catastrophise what can happen in open or crowded spaces (e.g. "what if one of these people attacks me?"), or over-estimate the danger they are in ("there's nowhere here that's safe"). As a result of this, the person might begin to avoid open spaces, becoming house-bound and rarely going outside.

Beck et al (1985) proposes that agoraphobics possess latent fears of situations that might have been potentially dangerous to a child but are not dangerous toadults, for example, crowded shops or open spaces. This explains the sensitisation.﻿

Here is another study which nicely illustrates the idea of cognitive vulnerability

﻿Research supporting the cognitive approach - Di Nardo et al (1988)﻿

﻿DiNardo et al. (1988) reported that 56% of dog phobics had an unpleasant encounter but about 50% of normal controls had also had such experiences and did not develop a phobia. Behaviourism ignores cognitive factors and so cannot account for individual variation. The fact that not all phobics have had a bad experience and s﻿ome non-phobics have had a bad experience and not developed phobia is probably due to the patients’ perception and interpretation, and so cognitive rather than behavioural factors are important.﻿

﻿Evaluation of cognitive explanations of phobias﻿

They accept the acquisition of fear through learning, for example, conditioning, but also emphasis the person’s own interpretation of events. They therefore present a more holistic explanation than some others.

The cognitive explanation is a coherent theory with practical therapeutic applications. The treatments have proved highly effective for anxiety disorders such as phobias. The success of the treatments supports the explanation.

Psychologists can conduct experiments to identify the different though processes of those who have a phobia and those who do not. This makes the explanation scientific and objective.

BUT behaviour is not always driven by cognitions, evidence suggests that cognitions can be driven and/or maintained by inappropriate behaviour such as avoidance. Therefore behaviourist ideas may sometimes be more effective for explaining a phobia.

Bullet point 3 - Treating phobias

﻿Two types of behaviourist treatments for phobias﻿

﻿Remember that behaviourists would explain phobias as a learned association between a certain stimulus (e.g. dogs) and a certain response (e.g. fear). Behaviourist therapies will therefore try to reduce the strength of these associations. There are two main methods used to try to do this﻿

﻿Systematic desensitisation﻿

﻿This involves the gradual exposure of the sufferer to the phobic object.

Developed by Wolpe (1958) it is based on the idea that two emotions cannot occur at the same time. There are 2 key aspects to this technique:• Getting people to practise relaxation techniques when feelings of tension and anxiety arise• A stepped approach to getting the person to face the object or situation of their phobia (a hierarchy).

e.g. The top of the hierarchy might be touching the phobic object, whereas the bottom of the hierarchy might be having one in the same room. Slowly, the object can be moved through the hierarchy until the fear can be replaced with relaxation.

﻿Virtual reality exposure therapy (VRET)﻿

﻿This is a new technique based on the principles of systematic desensitisation, but the therapy takes place in a virtual world. Although used largely to date with phobic patients, it is being trialled with other anxiety disorders too.

Patients are placed in a 3-dimensional virtual world where they wear a head mounted display which allows the individual to pick up sensory cues. A computer monitor shows the therapist wha﻿t t﻿he patient sees. This video shows it in action for arachnophobia﻿

﻿Flooding﻿

﻿This involves a sudden, overweening exposure to the phobic object; overwhelming the individual’s senses with the item or situation that causes anxiety so that the person realises that no harm will occur and in fact there is no objective basis for their fear.The steps that are involved in this are:1. A patient is exposed to the object/situation that causes anxiety (e.g. a room full of snakes)2. The patient is initially overwhelmed and very fearful, but this subsides after a while3. The patient recognises that anxiety levels have dropped and that although such situations have been avoided in the past, there is in fact no reason for this.

The video above shows this process:﻿

﻿Evaluating behavioural therapies for phobias﻿

Systematic desensitisation is supported by empirical evidence, which shows it often be an effective treatment for specific phobias (e.g. Lang and Lazovik).

Systematic desensitisation works well in the therapeutic situation and is a quick and cost effective method. However the therapeutic effect does not always generalise to the patient’s everyday life (as real life is not as controlled as the therapy).

﻿On vivo (real-life exposure) is more effective that in vitro (imagined exposure) for both flooding and systematic desensitisation.

VRET has advantages over systematic desensitisation as it is much easier and cheaper and often more convenient, but still has a similar level of success.﻿

﻿The equipment required for VRET is expensive and may not be suitable for all phobias. In addition patients do sometimes report negative side-effects e.g. nausea﻿

Systematic desensitisation can only be used when a particular phobic object/situation can be identified. It is suitable for phobias of snakes/spiders etc but not for generalised social phobias, so it is only useful for certain cases.

Flooding produces high levels of fear and this can be very traumatic, and therefore has ethical implications.

﻿Applied-tension therapy for phobias﻿

﻿The Applied Tension Technique is a strategy developed to help prevent fainting or help people recover faster if they do faint. It is specifically useful for phobias associated with fainting, usually needle and blood therapies.

The technique involves tensing the muscles in your body, which then raises your blood pressure. If your blood pressure increases, you are less likely to faint. Participants are taught to tense their major muscle groups at the first sign of faintness.﻿

﻿Ost et al (1989)﻿

﻿Abstract: Thirty patients with phobia for blood, wounds and injuries were treated individually with applied tension, applied relaxation, or the combination of these two methods for 5, 9 and 10 sessions. respectively. They were assessed on self-report, behavioural and physiological measures before and after treatment, and at a 6-month follow-up. All groups improved significantly on 11 12 measures, and the improvements were maintained at follow-up. Applying stringent criteria, 73% of the patients were clinically improved at the end of treatment and 77% were so at follow-up. Despite a failure to find between-group differences, on many measures there was a trend favouring applied tension. Since this method is as effective as the other treatments in only half the time, applied tension should clinically be the treatment of choice for blood phobia.﻿

﻿Assignment 7 - Summarising research﻿

﻿Write three conclusions and three evaluations of the study described above.﻿

﻿Applied tension - how to do it﻿

﻿Sit in a comfortable chair and tense the muscles in your arms, legs and trunk for about 10 to 15 seconds.

You should hold the tension until you start to feel a warm sensation in the head. Then, relax your body for 20 to 30 seconds.

Repeat 5 times.

TIP: When you relax your muscles after tensing them, the goal is not to become completely relaxed, as this will cause your blood pressure to drop. Rather, the goal is to let you body return to a normal state (not overly tense or completely relaxed).

It is important that you practise this strategy several times a day for at least a week.﻿

﻿Evaluating applied tension theory﻿

﻿Applied tension seems to be as effective as the other treatments in only half the time of other therapies, making it a quick and cost-effective treatment option for certain phobias.

As the patient can perform the therapy themselves after training, they are able to manage their own condition.﻿

﻿It is only useful for blood, needle and wound phobias associated with fainting, not for any other phobias. Therefore it is not useful for all types of phobias.

Ost et al (1989) state that "despite a failure to find between-group differences, on many measures there was a trend favouring applied tension." In other words, applied tension did not actually perform significantly better than relaxation on some measures of their study.﻿

﻿Cognitive-behaviour therapy for phobias﻿

﻿You know by know that the aim of cognitive therapy will be to replace unrealistic and fearful thinking about phobias with more realistic mental habits. It teaches patients to identify, challenge and replace counter-productive thoughts with more constructive thinking patterns. The task is to get the client to see that their thoughts are irrational and not based in reality.﻿

﻿Remember RET?﻿

You should remember Ellis' RET (1970) from the abnormal affect page. It can also be used to treat phobias! The client tells the therapist exactly what unrealistic, distorted and catastrophic thoughts they have. The therapist helps the client change these thoughts to ones that are rational andmore normal ways of thinking.

﻿Cognitive rehearsal﻿

﻿Cognitive rehearsal helps the individual to think about and mentally rehearse appropriate behaviours, so that when it comes to the real thing these behaviours can be enacted. It helps to stop the person thinking about the negatives.

For example, in social phobia a client is asked to think about specific behaviours that are appropriate to the social situation, they then rehearse the appropriate behaviours to perform. For example clearly introducing themselves and saying what the topic of the presentation is, referring to notes when the different slides come up, looking at the audience and asking if anyone has any questions at the end of the presentation. When it comes to the actual presentation the client enacts these behaviours.

﻿Challenging distorted thinking often also involves using counterstatements.﻿

﻿Using Counterstatements﻿

Examples of counterstatements for some of the common cognitive distortions associated with phobias. Click to enlarge.

﻿Key study - Ost and Westling (1995)﻿

Assignment 7

Write half a page from memory summarising each treatment option listed in this section

﻿Aim - To compare cognitive behaviour therapy (CBT) with applied relaxation as therapies for panic disorder. Method - A longitudinal study with patients undergoing therapy for panic disorder. Design - Independent measures design with patients being randomly assigned to either applied relaxation or CBT. Participants - 38 patients with DSM diagnosis of panic disorder, with or without agoraphobia. Recruited through referrals from psychiatrists and newspaper advertisements. 26 females and 12 males, mean age 32.6 years (range 23–45 years). From a variety of occupations and some married, some single and some divorced. Procedure - Pre-treatment: baseline assessments of panic attacks, using a variety of questionnaires (e.g. the Panic Attack Scale, Agoraphobic Cognitions Questionnaire, etc.). Patients recorded details of every panic attack in a diary. Each patient was then given 12 weeks of treatment (50–60 minutes per week), with homework to carry out between appointments. Findings - Applied relaxation showed 65% panic-free patients after the treatment, 82% panic-free after one year. CBT showed 74% panic-free patients after the treatment and 89% panic-free after a year. These differences were not significant. Complications such as generalised anxiety and depression were also reduced to within the normal range after one year. Conclusion - Both CBT and applied relaxation worked at reducing panic attacks, but it is difficult to rule out some cognitive changes in the applied relaxation group even though this is not focused on in this research.﻿

Evaluating cognitive therapies - YOU'VE SEEN THESE BEFORE!!!

﻿There is a lot of empirical evidence to support cognitive therapy for anxiety disorders, particularly when combined with behavioural techniques.

Patients may be less likely to relapse than those given biological treatments as they are being given the skills to self-manage their condition (which drugs don't provide)﻿

﻿Although we know that CBTs are often effective, it is not clear whether the cognitive or the behavioural aspect are the most important in the improvement. It could be that behavioural factors are causing the improvement.

Although changes in patients’ cognitions must take place during cognitive therapy, it is not clear what element of the therapy is most effective. It might be that any cognitive change is a consequence of some other factor (e.g. medication or lifestyle change) and not the intervention by the therapist.﻿

End of sectio﻿n e﻿ssay writing exercise - Section B

14 (a) Describe what psychologists have discovered about phobias. [8] (b) Some psychologists argue that phobias are learned just like any other behaviour. Evaluate what psychologists have discovered about phobias and include a discussion of the behaviourist explanation of phobias. [12]

First read this document, which covers the skills that we want you to learn when approaching these questions. In summary, you need to try to mention a range of information in question a), so try to mention things from all three bullet points in the specification (so here, something from each of the three approaches). For the question b), try to evaluate using issues and debates (same ones as from AS level). On this page, issues such as reductionism, determinism, ethics, data collection methods, scientific-ness, objectivity and other have been mentioned. Use these in your evaluations! Remember to use a PEE format if you find it helpful.

One final point. Make sure you answer the specific question asked! The 2 b) question will always have a little extra requirement in it, where it will ask you to focus your discussion on one specific area or issue. Here is it the behaviourist explanation. At least a paragraph should consequently be devoted to discussing the behaviourist approach.

Generic mark schemes are given below. Read them carefully before you start writing and make sure your essays fulfill all the requirements. Please submit your essays through the form on the home page.

End of se﻿ction essay writing exercise - Introducing Section C

Section C in your exam always consists of two questions, one 6 mark recall question and one 8 mark application question. There are always two of these types of question, an﻿d you need to choose one.

You are a practis﻿ing psychotherapist and you know how to treat patients and the underlying causes of disorders. One of your patients is a male who has a fear of women.

15 a) Describe the main features of psychotherapy. [6]15 b)﻿ Suggest how you would use psychotherapy to help your patient to resolve his fear of women. [8]﻿

The first question is a straightforward recall question. This is the longest question you will get which could focus on just a single theory. You need to write about half a page, so a simple revision check is to make sure that you can write half a page of description about every idea/theory/study that is specifically mentioned in the specification.

The second question allows you to be creative. There is no single right answer. All you have to do is give practical and specific ideas for how you might implement the theory you have described in the first question into the scenario they give you. About a page should be a good length. Here you have to suggest how you would use psychotherapy to treat the patient. You therefore need to make sure that you are specifically referring to ideas of psychotherapy, and to the condition given in the question. It takes some getting used to writing this way, but it is an area that, with a little bit of practice, you will be able to do very well on.

Have a go at the questions above. Please submit your essays through the form on the home page.